Post-traumatic ventricular septal defect manifesting as intermittent third-degree atrioventricular block: a case report.

Background: Traumatic cardiac injuries are rare, but patients may present with symptoms like arrhythmias, heart failure, or cardiogenic shock. Case summary: A 50-year-old Caucasian construction worker was admitted to our emergency department with a new-onset third-degree atrioventricular (AV) block following a traumatic blunt chest injury at work. The arrhythmia was controlled by a continuous application of isoprenaline. After stabilization, the electrocardiogram showed sinus rhythm with a new-onset left bundle branch block. Transthoracic echocardiography revealed a ventricular septal defect, which could be confirmed by transoesophageal echocardiography, including a contrast study; however, the patient was initially rejected for acute cardiac surgery due to haemodynamic stable conditions. After several hours, the patient developed acute dyspnoea with pulmonary oedema and cardiogenic shock. Echocardiography revealed severe tricuspid regurgitation caused by rupture of the anterior papillary muscle, and the patient was immediately transferred to the department for cardiac surgery for acute ventricular septal patch plastic and tricuspid valve replacement. Post-surgery, the patient developed haemodynamically compromising third-degree AV block, required catecholamines and temporary transvenous pacing. A permanent pacemaker implantation was performed on the following day. Discussion: Mechanical complications after blunt chest injury are rare and surgical repair in unstable conditions are still the treatment of choice. In concomitant conduction disorders, close monitoring for arrythmias is obligatory in the early phase; however, implantation of a permanent pacemaker is often necessary.